North Carolina is making strides to promote transparency and accountability for insurance consumers.
Last week, the state announced the launch of Insurance Smart NC, a consumer assistance program from the Department of Insurance partially funded by a grant under the Patient Protection and Affordable Care Act. The site includes an application for consumers to file complaints against insurance companies and information on insurance consumer rights.
Since April, they've handled 600 cases under a soft launch, half of which had their denial of coverage overturned with a total of $3,000,000 in services.
“More consumers will see savings and better results for insurance policies that they pay their premiums for,” says NC Department of Insurance commissioner Wayne Goodwin. Both the information and external review component had existed in the past, but under the grant, they were able to consolidate the two. “You’ll see consumers who will have more comfort when they hit a road block that they have an ally,” adds Goodwin.
This means human resources managers will also have an ally when dealing with employees who are denied treatment.
“Smart NC will provide additional help and be a new tool for HR managers. They want to help the best they can the employees of a business and any guidance they can give to the employee that could solve a problem is good for business and company morale,” Goodwin says.
Services are provided at no cost to the consumer, and the program can assist those covered by private health insurance, group health plans, state and federal high risk pools or any other kind of public health coverage.
“My impression is that most consumers aren't aware that they can file an appeal or get more information on what their health benefits package means and what services they can get,” says Shawn Nowicki, health policy director at HealthPass New York, a commercial health insurance exchange. “The information component is really important. In the past decade we're moving into greater transparency, much like it is in other consumable goods, it benefits everyone involved, not just the consumer, but the providers and insurers.”
But some critics aren't as hopeful about what such a website could mean for states.
“What can they really do? They can put something out there, but there’s no teeth in it,” says Keith Larey, director of human resources at Austin College, which has a self-funded benefits package. “People complain about the benefit itself but there's an expectation that when people go to the doctor and walk away thinking they shouldn’t owe any money.”
However, the external review component is the last option for contesting an insurance company’s denial outside of the legal system and, in most cases, can be used after your attempts to gain coverage through the insurer’s own appeal process have been made but were unsuccessful. Employees under a self-funded employer health plan are not eligible.
Such a program could be implemented by other states, depending on the leadership in each state; Goodwin authorized his staff to apply to every federal grant offered after PPACA, while other states have returned grant money, such as Kansas and Oklahoma.
“In one form or another, every state could benefit from a program like this,” Goodwin says of the program that does not use tax dollars. “We have a long history of fighting for people and being consumer advocates and being ardent of consumer protection.” Goodwin says they've already applied for a grant extension that would extend the service past the year it's slotted to last.
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